Newb needs help. Exhaling issues

Brad S · Post by **Brad S** » Mon Jul 25, 2022 12:14 pm

Hello everyone!
I have been searching topics here for the past two days and have found so much helpful information. I have so many questions and in the future, I will keep them in this thread.
The very first thing I need help with is figuring out how to exhale using the Resmed P10 nasal pillow mask. Air level is set to 5 and I am set to 3 on the pressure relief.
I was first diagnosed on June 17th and received my Airsense 11 Autoset machine last Thursday, July 21st and began using it that night. I set up my machine and used the test drive feature on the app to try everything out. Test drive no longer works.
The first night I had 4:42 usage and didn't seem to have too much difficulty. I woke up in the early in the morning with the mask off and I put it back on as I was waking up. I noticed at that time it was difficult to exhale.
Friday and Saturday nights were a disaster. I fell right to sleep but woke up breathless with the mask off and had trouble breathing normally for a few hours afterwards.
I read so much information here from others with the same problem. Yesterday I made some adjustments and switched from the medium to large nasal pillow.
I was so tired yesterday, Sunday, after I made the changes to the mask, I put it on and had zero problems exhaling. After 10 minutes of lying in bed breathing, I told my wife I was going to take a nap. I fell soundly asleep and slept better than I have in years. I woke up an hour and forty minutes later feeling really good. After I woke up I kept the mask on for 5 minutes or so just making sure my breath was ok. I felt great and was looking forward to going to bed last night.
Last night was awful! I can't exhale very well. I feel horrible and my brain fog is back and I am having a difficult time focusing writing this post.
It feels like I am always breathing very warm air. I have the machine temperature set to 60° and it still feels really warm.
I am determined to figure this out. My wife uses a machine and I see the benefits firsthand. I will not give up but I need sleep.
My doctor is off until Wednesday but her staff is answering her email. I have not heard from them yet.

Thank you for reading this. Any suggestions are greatly appreciated.

Pugsy · Post by **Pugsy** » Mon Jul 25, 2022 2:56 pm

What are ALL of your settings?
Mode?
Pressure settings...fixed or variable with a range??? What are they?

EPR at 3 but with a setting of 5 means you are really only getting 1 cm drop during exhale because the machine can't go below 4 cm. This alone can make people think they can't exhale or move enough air to be comfortable.

I would suggest setting the machine to 7 instead of 5 and see how that works out for you.

Get OSCAR...lets make sure that you aren't having a truckload of apneas as well.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
http://www.apneaboard.com/wiki/index.ph ... ganization organize and how to do screen shots.
wiki/index.php/Oscar:organize Wiki

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

ChicagoGranny · Post by **ChicagoGranny** » Mon Jul 25, 2022 3:27 pm

Brad S wrote: ↑
Mon Jul 25, 2022 12:14 pm
The first night I had 4:42 usage and didn't seem to have too much difficulty.

Brad S wrote: ↑
Mon Jul 25, 2022 12:14 pm
I woke up an hour and forty minutes later feeling really good.

I take this as strong evidence that you can easily exhale against the pressure. It's somewhat common for newbies to think they can't. They are concentrating on their breathing and trying to control it. If they can relax, forget about breathing, and fall asleep, they breathe gently and rhythmically all night. This can be easier said than done when you are starting first out.

But yeah, OSCAR, blah, blah, definitely - wouldn't do without it.

zonker · Post by **zonker** » Mon Jul 25, 2022 3:45 pm

Brad S wrote: ↑
Mon Jul 25, 2022 12:14 pm
Hello everyone!
I have been searching topics here for the past two days and have found so much helpful information.

1.welcome to the zoo!

2. thank you both for reading and for the promise to stay in one thread.

3. as pugsy said, let's see some oscar charts.

4. love your avatar! but i can't recall snoopy ever using his doghouse as, well, a house!

Brad S · Post by **Brad S** » Mon Jul 25, 2022 3:50 pm

Pugsy wrote: ↑
Mon Jul 25, 2022 2:56 pm
What are ALL of your settings?

Hello and thank you so much for your reply.
I have OSCAR downloaded and I am headed to the store later to get an SD card. The Airsense 11 does not come with one. I live 25 minutes from the closest store and will go after work.
Please let me know if I missed anything.

All my settings are as follows:
Ramp time -off
Pressure relief- on
Climate control- Auto
Tube temp- 60°
Mask setting- pillows
Smart start- On
Smart stop- On

On the clinical setting menu
Mode- Auto set
Pressure range- 5.0-6.0
Auto set response- standard
Ramp time- off
EPR- on
EPR type- full time
EPR level- 3
Climate control auto
Tube temp 60°
Mask setting- pillows
B/V filter- off
Patient view- advanced
Smart start- on
Smart stop- off

My Sleep View
used hours 4.5
Pressure 6
Leak- 2L/min
AHi1.9
Total AI- 0.6
Obstructive AI- 0.4

Pugsy · Post by **Pugsy** » Mon Jul 25, 2022 4:04 pm

My Sleep View
used hours 4.5
Pressure 6
Leak- 2L/min
AHi1.9
Total AI- 0.6
Obstructive AI- 0.4

Pressure range- 5.0-6.0

Your detailed report for pressure is probably going to show that you were maxed out at 6 cm for most of the night.
That is an extremely tight range for auto adjusting mode. I don't know if your detailed report will show a need for more pressure or not but we can cross that bridge later.

Note...that since you didn't have a SD card in your machine while using the machine you won't have any detailed data available from the SD card until after you have slept with the machine while the card is in it.
The detailed data and graphs aren't stored on the machine...it goes directly to the SD card so since you didn't have a SD card...no details. Only the summary data numbers are stored on the machine and those are the numbers you see on the LCD screen.

If going up a size in the nasal pillow resolved your breathing issues that is great but if you still are having problems exhaling or moving enough air then I would suggest increasing the minimum so you can get more of a drop while exhaling.
It's the drop that offers the amount of relief we feel...the bigger the drop the easier/better it feels.
Maybe 7 minimum and change maximum to 10 and see where it wants to go.

Brad S · Post by **Brad S** » Mon Jul 25, 2022 4:10 pm

Pugsy wrote: ↑
Mon Jul 25, 2022 4:04 pm

If going up a size in the nasal pillow resolved your breathing issues that is great but if you still are having problems exhaling or moving enough air then I would suggest increasing the minimum so you can get more of a drop while exhaling.
It's the drop that offers the amount of relief we feel...the bigger the drop the easier/better it feels.
Maybe 7 minimum and change maximum to 10 and see where it wants to go.

Thank you so much. I will let you know if changing the pressure to 7/10 helps and see if I can figure out OSCAR in the morning. Your directions are great.
What is odd to me is that when I napped with it yesterday afternoon, exhaling was great. Even after I woke up and then last night it was terrible.

clownbell · Post by **clownbell** » Mon Jul 25, 2022 6:14 pm

Brad - Be aware that there are normal night-to-night variations for no particular reason. And such variations are to be expected and not worried about or analyzed to the extreme. Maybe by coincidence your nap was at a particularly good time. As my granddaughters would say -- go figure. Hang in there.

Brad S · Post by **Brad S** » Tue Jul 26, 2022 8:53 am

Pugsy wrote: ↑
Mon Jul 25, 2022 2:56 pm
Get OSCAR...lets make sure that you aren't having a truckload of apneas as well.

Good morning-
I think I got this right. If not, just let me know.
Since I only got the memory card yesterday, I only have the data from one night.
So much information on these charts. I look forward to understanding it and figuring all of this out.
I was so tired when I went to bed last night, I passed out as soon as I laid down. I have no recollection of taking my mask off and when my alarm went off, I put my mask on and just laid in bed for a little while. Exhaling seemed a bit hard but better.
With your help, I feel like this is going to get better.
Thank you.

screenshot 1-20220726-083623.png

screenshot 2-20220726-083658.png

Brad S · Post by **Brad S** » Tue Jul 26, 2022 9:03 am

So, looking at all of the reports and checking out the graphs, does this mean I stopped breathing at this point?

screenshot 3-20220726-085957.png

screenshot 4-20220726-090031.png

Pugsy · Post by **Pugsy** » Tue Jul 26, 2022 9:20 am

Let's do some attachment storage house cleaning first.
You are attaching screen shots that are including graphs that we don't need and taking up precious attachment storage space.
See this thread please.
viewtopic/t183806/EVERYONE-PLEASE-READ- ... MENTS.html

The screen shots containing the graphs for minute ventilation down to AHI aren't needed.

We only need or want these graphs along with the usual stuff on the left side
Events
Flow rate
Pressure (not mask pressure)
Leak
Flow Limitations
Snores...only if very active..if not much there no need to include them.
See this thread please for examples.
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

So sometime today clean out your attachment storage and remove the screen shots that contain not needed graphs.
Otherwise there is a very real possibility the attachment feature will get full and you won't be able to attach anything.

The flat line on the one where you zoomed in on ...flat line at 22:01 to 22:03.....that's where you took the mask off for some reason. Looks like it happened early in the night where you might have been fiddling with things.
It just means that you weren't attached and the machine kept right on blowing but you weren't attached...Shorter version of what you did at 23:45 to 4:30.

BUT the 23:45 time where you took the mask off and didn't put it back on again until around 04:30....that means no therapy for your OSA while asleep for almost 5 hours. That's bad thing to do.

It's fairly common for newbies to take the mask off and not remember doing it. The brain just hasn't come to realize that this mask/cpap thing is a good thing so the brain prompts the human to remove the mask and the human won't remember doing it because they don't wake up enough to form a memory. If you continued doing this then you might want to tape your mask straps to your face so that the tape pulling on the skin when you are removing the mask in your sleep will cause you to wake up enough to stop the unwanted behavior.

Brad S · Post by **Brad S** » Tue Jul 26, 2022 11:40 am

Pugsy wrote: ↑
Tue Jul 26, 2022 9:20 am
Let's do some attachment storage house cleaning first.
We only need or want these graphs along with the usual stuff on the left side
Events
Flow rate
Pressure (not mask pressure)
Leak
Flow Limitations
Snores...only if very active..if not much there no need to include them.

Hello again-
I want to apologize for not understanding the directions the first time. I read through them and I saw where it said the new software version allowed attachments and did not read it completely.
Thank you for taking the time to explain it to me. I will get it figured out. I hope this one is better.

On the Statistics tab on OSCAR it shows my original pressure settings from my doctor at Min. 5.0 Max 15.0 Right now I have it set at 7 and 9. Does increasing it to 15 make a difference?

https://i.imgur.com/kHt5teQ.png

Thank you.

Pugsy · Post by **Pugsy** » Tue Jul 26, 2022 11:51 am

Brad S wrote: ↑
Tue Jul 26, 2022 11:40 am
On the Statistics tab on OSCAR it shows my original pressure settings from my doctor at Min. 5.0 Max 15.0 Right now I have it set at 7 and 9. Does increasing it to 15 make a difference?

Maybe.

Why did you reduce the max?

The machine won't go any higher than it thinks it needs to go to prevent the airway from collapsing. Limiting the max doesn't do anything with the algorithm in general but it could potentially allow the airway to collapse if you need more than 9 cm to hold it open and the machine can't go to where it needs to go.

The only time that limiting the max might be really needed is if going higher causes problems and the 2 main problems are possible centrals popping up at higher pressures (and lower pressures don't cause centrals) and this is relatively rare....or more commonly higher pressures causes aerophagia symptoms that disturb sleep or just plain make us miserable...air in the gut problems.

But at this point with the very limited data because you removed the mask prematurely in your sleep...there's really nothing to actually evaluate very well. You've really got about 2 hours of data and that's not really enough to even begin to establish any trends or patterns or anything really.

You have to keep the mask on all night to get accurate solid data to evaluate.

Brad S · Post by **Brad S** » Tue Jul 26, 2022 1:47 pm

Pugsy wrote: ↑
Tue Jul 26, 2022 11:51 am

Brad S wrote: ↑
Tue Jul 26, 2022 11:40 am

Why did you reduce the max?
Because I am a stoopid newbie. When I went into the clinical settings, I did not realize or understand what the minimum and maximum settings should be and, in my mind, I had no idea what I was doing so I figured better safe than sorry.
And besides, I was afraid at 15 I might blow myself up like a balloon

When I picked up the machine last Thursday, I received no instructions or counseling on how to use it. A nurse came out and I was handed the case and sent on my way. When I asked about it, I was told the instructions were inside. When my wife got her machine, her provider made us both go in for an in depth learning session. Hers was all about fit and operation, not settings. Her machine was set at the doctors, and she has never had a need to fiddle with the settings.

I will wait until I have more complete sleep data and post the results.
I still have not heard back from my doctor. You and the others have made me feel much better about all of this. I was worried the very first time I turned the machine on and had to jump off the bed due to the overwhelming panic I felt that I was not going to be able to do this. I will get through this for sure. I am very glad I have some place to go to ask questions- dumb or not. I am sure there will plenty more.
Thank you very much for your time and help.

Pugsy · Post by **Pugsy** » Tue Jul 26, 2022 1:53 pm

No problem. You aren't the first and won't be the last to make a newbie mistake.

BTW ...bet you didn't realize that even at max pressure of 20 cm blowing full time it won't even blow up a balloon.

Though I do admit that when new to all this that it does feel like hurricane force winds in the beginning.
You will adjust with a bit of time and experience.

Another BTW...sometimes babies are put on cpap for various reasons...babies..teeny tiny babies and they start off with 6 cm pressure even for babies with tiny lungs.

Rest assured you won't blow up like a balloon and go flying across the room.

Newb needs help. Exhaling issues

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